Lochside Dental Clinic Review

Transcription

1 Integratin Jint Bard 29 th Nvember 2016 This Reprt relates t Item 9 n the Agenda Lchside Dental Clinic Review (Paper presented by Julie White) Fr Apprval Apprved fr Submissin by Authr List f Backgrund Papers Appendices Angus Camern, Medical Directr Valerie White, Cnsultant Dental Public Health Appendix 1 Difficult Decisins Template Appendix 2 Engagement Plan

2 SECTION 1: REPORT CONTENT Title/Subject: Meeting: Lchside Dental Clinic Review Integratin Jint Bard Date: 29 th Nvember 2016 Submitted By: Actin: Valerie White Fr Apprval 1. Intrductin 1.1 At its meeting n 6 th Octber 2014, Dumfries and Gallway Health Bard apprved the recmmendatins f the Salaried Dental Service (nw Public Dental Service) review which cncluded that General Dental Services cntinue t be prvided at Lchside Clinic by the independent cntractr via a lease arrangement. A tendering exercise was undertaken during 2015 fr the prvisin f NHS General Dental Services frm Lchside Clinic but n alternative prvider applied t take ver service prvisin. The regulatins surrunding Transfer f Undertakings Prtectin f Emplyment (TUPE) make this ptin nn-viable in the shrt t medium term. 1.2 In Octber 2015, the NHS Bard apprved the prpsal t undertake a further service review t explre ptins fr future service delivery f rutine NHS General Dental Services frm Lchside Clinic. This review prcess was instigated prir t Integratin f Health and Scial Care Services. 1.3 This reprt prvides an verview f the prcess undertaken t date regarding the review f prvisin f rutine General Dental Services prvide by the Public Dental Services frm Lchside Clinic, the preferred ptin resulting frm the review prcess and als utlines the next steps t allw cmpletin f the review prcess prir t final decisin making. 2. Recmmendatins 2.1 The Integratin Jint Bard is asked t: 2.2 Nte the cmprehensive review prcess undertaken t date. 2.3 Nte the preferred ptin resulting frm the review prcess f cmplete withdrawal f rutine NHS General Dental Services prvided by the Public Dental Service frm Lchside Clinic with facilitated transfer f registered patients t independent dental cntractr practices. 2.4 Nte there will be a need t implement the final recmmendatins f the Lchside and Lincluden Oral Health Needs Assessment fllwing

3 cnsultatin t supprt imprvements in ral health and reductin in ral health inequalities regardless f the utcme f the decisin regarding the preferred ptin. 2.5 Apprve the recmmendatin t g ut t cnsultatin with patients and wider stakehlders in January 2017 n the preferred ptin as per the engagement plan. 2.6 Nte that a final paper fllwing cnsultatin will be presented t the Bard at the end f May 2017 fr final decisin making. 3. Backgrund 3.1 In 2006, registratin levels with an NHS Dentist in Dumfries and Gallway std at 33% f the ppulatin, with a waiting list f ver 30,000. Cnsecutive Scttish Gvernments have implemented varius plicy initiatives t imprve access t NHS Dental Services. This included granting NHS Bards the ability t establish Salaried General Dental Services in areas where access t independent cntractr General Dental Services was pr. 3.2 NHS Dumfries and Gallway established 7 Salaried Dental Clinics thrughut the regin which included, Dumfries Dental Centre, Lchmaben, Lchside, Castle Duglas, Newtn Stewart, Sanquhar and Stranraer. 3.3 Retractin f prvisin f rutine General Dental Services by the Public Dental Service was undertaken in Castle Duglas in 2008 and Stranraer in Fllwing a review f prvisin f rutine General Dental Services by the Public Dental Service in 2014, retractin f rutine General Dental Services tk place frm Lchmaben Dental Clinic and Dumfries Dental Centre (specialist services and teaching and training are still prvided frm Dumfries Dental Centre) and plans are in place fr retractin f services frm Newtn Stewart Dental Clinic in Spring As at March 2016, 85% f the ppulatin f Dumfries and Gallway were registered with an NHS Dentist 4. Main Bdy f the Reprt 4.1 As this piece f wrk has been identified as ptentially cntentius it has been prgressed thrugh the NHS Bard Difficult Decisins prcess. Appendix 1 cntains the cmpleted Difficult Decisin Template presented t the NHS Bard Management Team n the 27 th September 2016 and the Health and Scial Care Senir Management Team n the 6 th Octber The Health and Scial Care Senir Management Team recmmended that the Integratin Jint Bard be prvided with a paper n this review prir t undertaking any cnsultatin. Appendix 2 cntains the review Engagement Plan.

4 SECTION 2: COMPLIANCE WITH GOVERNANCE STANDARDS 5. Resurce Implicatins 5.1. Implementatin f the preferred ptin (service withdrawal) wuld result in an estimated net saving f 105k. With a reductin f 157k frm Lcal Public Dental Service budget and an estimated resultant increase f 52k spend frm the nndiscretinary Scttish Gvernment held General Dental Services budget. 6. Impact n Integratin Jint Bard Outcmes, Pririties and Plicy 6.1. The pririties set ut by the Bard are as fllws: Enabling peple t have chice and cntrl Supprting carers Develping and strengthening cmmunities Making the mst f well-being Maintaining safe, high quality care and prtecting vulnerable adults Shifting the fcus frm institutinal care t hme and cmmunity care Integrated ways f wrking Reducing Health Inequalities Wrking efficiently and effectively Making the best use f technlgy 6.2. Feedback frm the cnsultatin will help further infrm assessment f impact n Bard utcmes and pririties. Hwever, at this stage it is assessed that the preferred ptin falls within pririty 9 wrking efficiently and effectively, as the preferred ptin wuld seek t make best use f existing independent dental cntractr practices. Althugh the preferred ptin may appear t be in cntradictin t pririty 8 reducing health inequalities, it shuld be nted that 85.7% f the Lchside and Lincluden ppulatin are registered with an NHS dentist, f which the vast majrity (79%) are registered t receive dental care with independent dental cntractr practices. Only 6.9% (458 peple) f thse resident in the Lchside and Lincluden area are registered fr dental care at Lchside clinic. Reductin f health inequalities is a key pririty f the Bard and it wuld be imprtant that the recmmendatins frm bth the ral health needs assessment and equality and diversity impact assessment are implemented t supprt imprvements in health inequalities Scttish Gvernment guidance states that in areas f imprved access t NHS dental services, NHS Bards shuld be reviewing their prvisin f rutine NHS dental services by the Public Dental Service. 7. Legal & Risk Implicatins 7.1. Key areas f risk are:

5 Perceived Patient Experience: Patients f the Clinic have previusly made it clear that they highly value the service they currently receive and wuld like t cntinue t receive dental services frm their current clinic. Where withdrawal and transfer f patients has ccurred previusly, steps t mitigate cncerns were put int place. The NHS Bard is nt aware f any cmplaints fllwing the transfer f patients t the independent cntractr sectr fllwing withdrawal f rutine General Dental Services frm Lchmaben and Dumfries Dental Centre. Level f Interest: It is likely there will be a high degree f interest in this review due t the fact that the current service is prvided in an area f deprivatin and a perceptin that withdrawal f the service will lead t an increase in ral health inequalities. A briefing paper n the review has been shared with the Cuncillrs representing the Nrth West Dumfries area and a briefing paper was prepared fr the NHS Bard Chief Executive t share with MPs/MSPs. Hwever, this did nt detail the ptins under cnsideratin. The Oral Health Needs assessment recmmendatins will need t be implemented t supprt imprvements in ral health and reductin in ral health inequalities regardless f the utcme f the decisin regarding the preferred ptin. Briefing papers fr elected members will need t be prvided prir t cmmencement f the cnsultatin. Independent Cntractr Capacity: At present capacity reprted by the independent dental cntractr sectr is far in excess f that required t disperse patients frm Lchside Clinic. Hwever, it is recgnised that a prprtin f this capacity is prvided by dentists wh cme frm the Eurpean Unin. It is nt yet knwn what the impact f withdrawal f the UK frm the Eurpean Unin will have in regards t this. Hwever, it was assessed by the review grup that shuld this start t have impacts this wuld becme a much wider reginal issue, that keeping Lchside Clinic wuld nt in itself address. Of ur current independent dental cntractr wrkfrce, 45% are frm the EU. Staff: Is it acknwledged that it can be challenging t redeply dentists and dental nurses, redeplyment wuld be actively prgressed by Human Resurces. 8. Cnsultatin 8.1. The Scttish Health Cuncil prvided advice and supprt in develpment f the review engagement plan which has been implemented thrughut the review prcess. A 12 week perid f cnsultatin n the preferred ptin wuld cmmence frm the 9 th f January 2017 as detailed in the engagement plan (Appendix 2). In additin the views f the Strategic Planning Grup will be sught regarding the preferred ptin. 9. Equality and Human Rights Impact Assessment 9.1. Equality and Diversity has been cnsidered thrughut the review prcess. All shrtlisted ptins have been subject t an initial Equality and Diversity impact assessment. A further impact assessment f the preferred ptin fllwing cllatin f feedback n the preferred ptin will als be undertaken. The initial

6 Equality and Diversity impact assessment did nt identify areas f discriminatin based n prtected characteristics, but it did identify that actin wuld be required t mitigate the ptential impacts f all the shrt listed ptins. It was recgnised that Lchside Clinic has a high level f accessibility cmpared t ther independent dental cntractrs practices, but acknwledged that accessible independent dental cntractrs were available. It has been agreed that an update f accessibility f practices reprting current capacity with be undertaken prir t cnsultatin. 10. Glssary TUPE Transfer f Undertakings Prtectin f Emplyment

7 APPENDIX 1 Service Change / Disinvestment template Title f Prpsal Stage (delete as apprpriate) Lead Manager/Clinician COO/ Spnsring Directr Review f Prvisin f rutine NHS General Dental Services Prvisin frm Lchside Clinic X Initial - Phase 3 Valerie White Cnsultant Dental Public Health Angus Camern, Medical Directr and Katy Lewis, Directr f Finance 1. Brief descriptin f prpsal: (clarify whether:- budget reductin; redesign f service t make efficiency savings; service withdrawal/disinvestment; ther) Scttish Gvernment guidance states that in areas f imprved access t NHS dental services NHS Bards shuld be reviewing their prvisin f rutine NHS dental services by the Public Dental Service. At it s meeting n 6 th Octber 2014, Dumfries & Gallway Health Bard apprved the recmmendatins f the Public Dental Service review which cncluded that General Dental Services cntinue t be prvided at Lchside Clinic by the independent cntractr sectr via a lease arrangement. A tendering exercise was undertaken during 2015 fr the prvisin f NHS General Dental Services frm Lchside clinic, n alternative service prvider applied t take ver service prvisin. The regulatins surrunding Transfer f Undertakings Prtectin f Emplyment (TUPE) make this ptin nn-viable in the shrt t medium term. In Octber 2015, the NHS Bard apprved the prpsal t undertake a further service review f the Public Dental Service t explre ptins fr future service delivery f rutine NHS General Dental Services frm Lchside Clinic. Fllwing the Bards apprval f the recmmendatin t explre ptins fr future delivery f rutine NHS General Dental Services frm Lchside clinic, it was agreed by the implementatin grup that undertaking a further ptins appraisal exercise wuld be the mst apprpriate way frward. An engagement plan fr the review was devised with the supprt f the Scttish Health Cuncil (Appendix 2). Patients registered t receive dental treatment frm Lchside Dental Clinic were written t at the beginning f January 2016 advising that this review wuld take place and seeking feedback n what was imprtant t them in terms f NHS dental service prvisin. An ral health needs assessment f the Lchside and Lincluden Cmmunity has been undertaken; this included participatry appraisal wrk undertaken with the Lchside and Lincluden Cmmunity. These reprts were used t infrm an ptins appraisal, which included tw patient representatives and a representative frm DG Vice. The ptins appraised and the results f the appraisal are detailed in Table 1. Althugh ptin 2 and ptin 9a were relatively clse when scred qualitatively when the finance data was included ptin 2 (withdrawal f service with patients transferred t the independent cntractr sectr) clearly became the preferred ptin. It shuld be nted that ptins 3, 4a&b and 9a&b wuld require additinal financial investment by the Bard, further details f this are given in sectin 6. It is als nted that ptins 3, 4a&b and 9a&b wuld require additinal new patient registratins. There is a level f uncertainty as t whether these new registratins culd be achieved frm the existing unregistered ppulatin r whether new registratins wuld be drawn frm existing independent cntractr practices, which may have the ptential t destabilise these existing practices.

8 Table 1: Optin Appraisal Results Ranked in Order f Preference 1-7 Optin Descriptin Qualitative Financial Cmbined Rank Scre Scre Scre 2 Cmplete withdrawal f service with st facilitated transfer f registered patients t independent dental cntractr practices 1 Status Qu - n change in current service prvisin 9a Retentin f all existing registered patients and building capacity t utilize the 2 dental surgeries t prvide dental services t peple resident in the Lchside and Lincluden area (maximum capacity 3000) (1500 additinal Lchside and Lincluden area residents) Tw dentist mdel 9b Retentin f all existing registered patients and building capacity t utilize the 2 dental surgeries t prvide dental services t peple resident in the Lchside and Lincluden area (maximum capacity 3000) (1500 additinal Lchside and Lincluden area residents). One dentist and ne therapist mdel. 3 Facilitated transfer t independent dental cntractr practices f nly thse registered patients living ut with the Lchside and Lincluden area and utilizing remaining capacity t prvide dental services t peple resident in the Lchside and Lincluden area (maximum capacity 1500) 4 a Facilitated transfer t independent dental cntractr practices f nly thse registered patients living ut with the Lchside and Lincluden area and building capacity t utilize the 2 dental surgeries t prvide dental services t peple resident in the Lchside and Lincluden area (maximum capacity 3000). Tw dentist mdel nd rd th th th 4b Facilitated transfer t independent dental cntractr practices f nly thse registered patients living ut with the Lchside and Lincluden area and building capacity t utilize the 2 dental surgeries t prvide dental services t peple resident in the Lchside and Lincluden area (maximum capacity 3000). One dentist and ne therapist mdel th Lchside Clinic is situated in Nrth West Dumfries, an area classified as within the 20% mst deprived areas in Sctland. Pr ral health is assciated with deprivatin. During the initial ptins appraisal exercise in 2014, the ptin t withdraw NHS General Dental Services frm this clinic was nt shrtlisted fr further appraisal. The review grup did nt

9 shrtlist withdrawal at that time fr the fllwing reasns: N ther accessible dental service within the vicinity Cst f public transprt Current need fr the service Area f deprivatin It was agreed that the abve areas required further explratin and an Oral Health Needs Assessment Exercise was undertaken t help infrm the ptins appraisal prcess. The needs assessment lked at relevant quantitative data regarding ral health and access t dental services and als included qualitative data gathered frm the Lchside and Lincluden cmmunity via participatry appraisals methds. Lchside patient feedback n what was imprtant t them regarding prvisin f their dental care was als cllated and reviewed. These reprts helped t infrm the ptins appraisal prcess. The high level findings can be summarised as fllws: Althugh it requires interpretatin with cautin, the Oral Health f Primary 1 children in the Lchside and Lincluden area des appear t be prer than Primary 1 children mre generally in Dumfries and Gallway. This is nt unexpected given the deprivatin level f the area. The nurseries and primary schls in the area benefit frm inclusin in the Childsmile Oral Health Imprvement Prgramme. Data n the ral health f adults fr the Lchside and Lincluden area is nt available; hwever, it is likely that ral health f adults will generally be prer due t the deprivatin status f the area, cmpared t thse in mre affluent areas. At a Scttish level a significant prprtin f the adult ppulatin reprt sme level f anxiety abut attending the dentist. Barriers t attending the dentist reprted at a Scttish level include difficulty in getting an appintment that suits, the expense f dental treatment, difficulty in getting time ff wrk and distance t g t a dentist. Dental Registratin figures fr the Lchside and Lincluden area are high, 86% f the ppulatin are registered with an NHS dentist. Dental Registratin rates are lwest fr the 0-2years 11mnth age grup at 37% f this age grups ppulatin. Only 458 peple frm the Lchside and Lincluden area are registered at the Lchside clinic (6.9% f the Lchside and Lincluden ppulatin) 66% (876) f the peple registered t receive dental treatment at the clinic live utwith the Lchside and Lincluden area. It is estimated that apprximately 950 peple living in the Lchside and Lincluden area are nt registered with an NHS dentist (14% f the ppulatin f this area). The infrmatin reviewed in relatin t participatin with NHS dental services did nt appear t supprt the cnclusin that the lcatin f the clinic necessarily influences participatin in NHS dental services. Individuals living in the Lchside and Lincluden cmmunity are registered at a number f different General Medical Practices thrughut Dumfries Twn. Frequent bus rutes were nted t cnnect Lchside and Lincluden t Dumfries twn centre. Whilst transprt/access was mentined by sme individuals in the participatry appraisal as an issue fr accessing dental services, wider and mre cmplex reasns which may cntribute t attendance at the dentist were highlighted including csts f dental treatment, fear f dental treatment, lack f awareness f the need t attend a dentist (particularly fr thse wearing dentures) and reprted pr previus experiences. A number f thse wh participated in the participatry appraisal did advise that they wuld like t be registered at the Lchside clinic. Patient feedback demnstrated that patients highly value the existing dental service

10 prvided frm Lchside Clinic and see the clinic as being cnvenient and having adequate parking. Whilst access t dental services is an imprtant factr in maintaining ral health it must be recgnised that there are many factrs that influence an individual s general and ral health and wellbeing. Emerging research aimed at tackling ral health inequalities is challenging the current dwnstream apprach which tends t fcus n disease specific individual preventin and utlines the need t wrk in partnerships acrss sectrs and disciplines t address the wider determinants f health including the scial, ecnmic, cmmunity and envirnmental factrs. The imprtance f giving pririty t interventins targeting early life is als prmted. There is a great deal f excellent partnership wrk already nging in the Lchside and Lincluden area. The fllwing recmmendatins identified in the Oral Health Needs Assessment utline sme additinal areas f wrk that shuld be taken frward t supprt a reductin in bth general and ral health inequalities. The 1986 Wrld Health Organisatin Ottawa Charter utlined five key areas f actin fr prmting health. This framewrk has been used t structure the draft needs assessment recmmendatins which will supprt a reductin in bth general and ral health inequalities and shuld be implemented regardless f the decisin regarding the preferred ptin. Healthy Public Plicy Link with clleagues acrss Dumfries and Gallway and Natinally t: Increase advcacy fr reductin in sugar cnsumptin Increase advcacy fr restrictin f marketing f unhealthy fds and drinks t children and imprved fd labelling. Creating Supprtive Envirnments Ensure ral health is included in health and wellbeing plans fr schls and nurseries Prvide additinal supprt t schls/nurseries/early years grups in the Lchside and Lincluden area re develpment f healthy fd and drink plicies and in their implementatin. Wrk with schls in the Lchside and Lincluden area t supprt expansin f the schl tthbrushing prgramme all thrugh the schl Wrk with health visiting teams in the Lchside and Lincluden area t increase the amunt f supprt prvided t yung families via the Childsmile practice prgramme t encurage increased rates f dental registratin in the early years f life. Strengthen fllw up supprt pathways fr children identified as having ptential dental prblems fllwing fluride varnish applicatin in nurseries and schls in the Lchside and Lincluden area Explre the pprtunity t include tthpaste and tthbrushes in fd bank packages fr families living in the Lchside and Lincluden area. Strengthening Cmmunity Actin Undertake cmmunity engagement with families and lder peple living in the Lchside and Lincluden area regarding ral health.

11 Supprting Behaviur Change Prvide Cntinuing Prfessinal Develpment (CDP) pprtunities t thse invlved in supprting ral health behaviur change t ensure that behaviur change techniques are based n evidence based psychlgical thery. Re-rientatin f dental healthcare systems Prvide CPD pprtunities fr dentists and dental teams regarding ral health inequalities. Wrk with dental practices t ensure that apprpriate clinical preventin is prvided t children and adults at high risk f develping dental decay. Wrk with dental practices t review their appintment systems fr thse individuals wh may require a greater degree f flexibility due t challenging persnal circumstances. Prvide supprt t dental practices t help them link t ther relevant services and agencies within their lcal cmmunity Prmte the pprtunity fr individuals within the Lchside and Lincluden Cmmunity t receive dental treatment via the Dental Student Outreach Clinic at the Dumfries Dental Centre. 2. Cntributin t planning &/r crprate bjectives: Implementatin f ptin 2 wuld be: In line with gvernment plicy f independent dental cntractrs being the preferred service delivery mdel fr prvisin f rutine General Dental Services. Maximise the benefit f the financial allcatin by delivering clinically and cst effective services efficiently thrugh utilisatin f existing independent cntractr dental services 3. Impact n service and staff: (include details f wrkfrce - by staff grup & wte /training /lcatins) Implementatin f ptin 2 wuld have the fllwing impacts: Service There wuld be n prvisin f NHS dental services frm Lchside clinic. Staff 1 x 0.8 WTE Dentist 1 x 0.8x WTE Dental Nurse 1x 1 WTE. Receptinist (Fixed Term Cntract) Staff wuld be cvered by the Bards Organisatinal change plicy. It is acknwledged hwever, that re-deplyment f dentists and dental nurses is difficult. 4. Assessment f impact n: i) All patients: If ptin 2 were implemented: Patients wuld need t change the current lcatin f prvisin f NHS dental treatment and wuld need t change their dentist. Hwever, they wuld cntinue t receive dental

12 treatment under the same NHS General Dental Service terms and cnditins. This transfer wuld be facilitated by the Bard. Frm the patient feedback already received it is clear that patients are very happy with the service prvided frm Lchside clinic and withdrawal f the service is likely t be very cntentius. ii) Different equality grups (legislated prtected characteristics)*: N Describe hw impact will be Negative Psitive Impact mitigate Age X X Disability X X Additinal supprt thrugh the transfer prcess wuld be required. Recmmendatins frm Oral Health Needs Assessment shuld be implemented t supprt a reductin in inequalities in ral health. Current practice has a high level f accessibility cmpared t ther independent dental cntractrs. An update f the accessibility f independent dental cntractr practices wuld need t be undertaken prir t cnsultatin. Gender Reassignment X Marriage/Civil X Partnership Pregnancy/Maternity X Race X Religin r Belief X Sex Sexual Orientatin X * undertake Equality Impact Assessment (EQIA) fr all Develped / Full prpsals Equality and diversity has been cnsidered thrughut the review prcess. All shrtlisted ptins have been subject t an initial equality and diversity impact assessment. A further impact assessment f the preferred ptin fllwing cllatin f feedback n the preferred ptin will als be undertaken. The initial equality and diversity impact assessment did nt identify areas f discriminatin based n prtected characteristics but it did identify that actins wuld be required t mitigate the ptential impacts f all the ptins. It was recgnised that Lchside clinic has a high level f accessibility cmpared t ther independent dental cntractrs practices, but acknwledged that accessible independent dental cntractrs were available. It has been agreed that an update f accessibility f practices reprting current capacity will be undertaken prir t cnsultatin if it is agreed that cnsultatin n ptin 2 is t be prgressed. iii) Other NHS services: If ptin 2 were implemented: Pdiatry services and paediatric speech and language run clinics frm the Lchside clinic, it is fr ther services t review their wn service delivery plans in line with the needs f their service users. This shuld happen independently f any changes t prvisin f dental services frm Lchside Clinic. Withdrawal f dental services prvides the pprtunity fr ther services t utilise the remaining space within Lchside clinic.

13 Pdiatry services are prvided frm Lchside Clinic tw days a week (Mn and Thursday) an additinal clinic is als prvided nce a mnth n a Wednesday. The pdiatry clinics utilise the supprt f the dental receptinist t assist with running f the clinic i.e. letting peple int the clinic, being a presence shuld a patient take unwell. If dental services where withdrawn frm Lchside clinic Pdiatry services wuld need t cnsider hw t prvide the necessary clinic supprt. Paediatric speech and language therapy services are prvided frm Lchside clinic 2 days per mnth. It is the intentin t mve these clinic sessins t Lchside Children s Centre after December There wuld be a reductin in thrugh put f dental equipment fr Central Sterilisatin Services (CSSD). As identified within the Oral Health Needs Assessment recmmendatins there will be a need t increase cllabrative wrk between the Oral Health team and with ther health services and scial care services, such as health visiting and Nithsdale Health Imprvement team t address sme f the wider determinants f pr ral health. iv) Partner rganisatins: If ptin 2 were implemented: As identified within the Oral Health Needs Assessment recmmendatins there will be a need t increase wrk with partner rganisatins, such as educatin, early years services and welfare services t address sme f the wider determinants f pr ral health. v) The lcal ecnmy and suppliers: If ptin 2 were implemented: This wuld increase sustainability f the independent cntractr sectr and shuld supprt jbs in the lcal ecnmy. vi) Other stakehlders: Nt applicable 5. Accmmdatin/estates impact (particularly in respect f access issues): Space wuld becme available in Lchside clinic t allw prvisin f ther services r fr clleagues in estates t cnsider the apprpriateness f retentin f this facility. 6. Anticipated full and part year savings: (include grss savings & any spend t save investment required) Csts f Implementatin f each ptin are utlined in Table 2 Table 2 Ttal Annual Csts f Implementatin f Each Optin ( ) Optin 1 Optin 2* Optin 3 Optin 4a Optin 4b Optin 9a Optin 9b 157,158 52, , , , , ,959 *Assuming full redeplyment. Implementatin f Optin 2 (Service withdrawal) wuld result in an estimated net saving f 105k. With a reductin f 157k frm Lcal Public Dental Service Budget and an

14 estimated resultant increase f 52k spend frm the nn-discretinary Scttish Gvernment held General Dental Services Budget. Optins 3, 4 and 9 wuld require additinal investment f a range f 14k- 106k dependent n the ptin cmpared t Optin 1 (Status Qu). 7. Benchmarking / Best Value: (describe hw the prpsal has been benchmarked & best value assured) This has been undertaken via the financial aspect f the ptins appraisal prcess. 8. Key tasks required t deliver utcme: (include implementatin plan; when will savings impact; measures f success) Key tasks t be undertaken prir t any decisin making prcess. Views n preferred ptin sught frm Strategic planning grup January 2017 Patient/Cmmunity Engagement n preferred ptin January - April 2017 Patient/Cmmunity/Stakehlder Engagement n Oral Health Needs Assessment Recmmendatins January - April 2017 Cnsultatin with Independent Dental Cntractrs January - April 2017 Final Reprt t relevant Bard fllwing engagement May/June Cnsultatin/cmmunicatin required/ undertaken: (include Staff Partnership prcess) The Oral Health Needs Assessment has invlved patient and public engagement n the brader tpic f ral health and access t dental services fr the Lchside and Lincluden Cmmunity. This engagement wrk has been undertaken by the Participatry Appraisal Netwrk and helped infrm the ptins appraisal prcess. Registered patients at the clinic have been asked what is imprtant t them regarding dental service prvisin and the resultant reprt helped infrm the ptins appraisal. The Optins Appraisal included tw patient representatives and a representative f DG Vice. A briefing paper will be prduced fr Lcal Cuncillrs and MSPs wh represent the Nrth West Dumfries area prir t cnsultatin n the preferred ptin. Patient/Cmmunity Engagement will be undertaken regarding the preferred ptin. The Scttish Health Cuncil prvided advice and supprt in develpment f the review engagement plan which has been implemented. Further cnsultatin is planned as utlined in sectin 8 Key Tasks. The Scttish Health Cuncil have advised that a minimum f 6 weeks cnsultatin/engagement wuld be required and that pprtunities fr public meetings shuld be available if a demand fr this exists. A 12 week cnsultatin has hwever been agreed. Wrk has cntinued with Unisn and the British Dental Assciatin fllwing the initial review and representatin f these unins were invlved in the ptins appraisal. 10. Key risks / Hw risks will be managed: (cnsider use f Bard s risk management matrix) If ptin 2 were implemented: Risks assciated with the preferred ptin will be assessed thrughut the prcess.

15 Hwever, based n previus experience it is likely that the fllwing risks may be encuntered: Perceived Patient Experience Patients have previusly made it clear that they highly value the service they currently receive frm their clinic and wuld like t cntinue t receive dental services frm their current clinic. Where withdrawal and transfer f patients has ccurred previusly steps t mitigate cncerns were put in place. The Health Bard is nt aware f any cmplaints fllwing the transfer f patients t the independent cntractr sectr fllwing withdrawal f rutine General Dental Services frm Lchmaben and Dumfries Dental Centre. Level f Interest It is likely that there will be a high degree f interest in this review due t the fact that the current service is prvided in an area f deprivatin and a perceptin that withdrawal f the service will lead t an increase in ral health inequalities. A briefing paper n the review has been shared with Cuncillrs representing the Nrth West Dumfries area and a briefing paper was prepared fr the Chief Executive t share with MPs/MSPs. Hwever, this did nt detail the ptins under cnsideratin. The Oral Health Needs assessment recmmendatins will need t be implemented in full t supprt imprvements in ral health and reductin in ral health inequalities regardless f the utcme f the decisin regarding the preferred ptin. Independent Dental Cntractr Capacity At present capacity reprted by the independent dental cntractr sectr is far in excess f that required t disperse patients frm Lchside clinic. Hwever, it is recgnised that a prprtin f this capacity is prvided by dentists wh cme frm the Eurpean Unin. It is nt yet knwn what the impact f withdrawal f the UK frm the Eurpean Unin will have in regards t this. Hwever, it was assessed by the review grup that shuld this start t have impacts this wuld becme a much wider reginal issue, that keeping Lchside clinic wuld nt in itself address. Of ur current independent dental cntractr wrkfrce 45% are frm the EU. Staff It is acknwledged that it can be challenging t redeply dentists and dental nurses, redeplyment wuld be actively prgressed by Human Resurces. 11. Ptential Unintended Cnsequences / Hw these will be managed: If ptin 2 were implemented: Increased waiting times fr appintments in the independent cntractr sectr. Managed by transferring patients at the end f a curse f treatment, r thse wh have cmpleted treatment and are awaiting a rutine recall appintment. This wuld mean that the majrity f patients transferred shuld be dentally fit and nt have high treatment needs. Wrk culd als be undertaken with the independent cntractr practices t explre means f increasing service capacity thrugh changes in skill mix. 12. Ptential Other Optins: The fllwing ptins were cnsidered but were nt put thrugh the ptins appraisal prcess fr the reasns utlined belw:

16 Optin 5 Retentin f Service until the dentist leaves then mve t withdraw Reasn Fr Rejectin Nt apprpriate t plan service prvisin based n persnal circumstances f staff Optin 6 Retentin f Lchside and Lincluden area patients with dispersal f thse living ut with this area Reasn fr Rejectin Clinic wuld becme inefficient Number f patients wuld nt warrant full time dentist therefre wuld becme difficult t prvide the service accrding t NHS General Dental Service Terms and Cnditins Optin 7 Re-attempting Leasing f clinic t the independent Dental Cntractr Sectr Reasn fr Rejectin The regulatins surrunding TUPE make this ptin nn-viable in the shrt t medium term. Optin 8 Prvide Special Care Prgramme frm Clinic Reasn fr Rejectin Previusly been agreed t centralise the special care prgramme in Dumfries Dental Centre and Stranraer t make mst efficient use f specialist resurces Fr Fully Develped Prpsal In additin t cmpletin f template, cnfirm that all requirements are cmpleted and infrmatin/ details attached (Tick) Cnsultatins (full range) Evidence Optin appraisal (if apprpriate) Ethic-legal values / principles Finance checked Risk Assessment

17 APPENDIX 2 Engagement Plan: Review f Prvisin f Rutine General Dental Services by the Public Dental Service Frm Lchside Clinic Backgrund The NHS Refrm (Sctland) Act 2004 states that Health Bards shuld ensure patients are invlved in planning and develping services. Invlving patients can help services meet need. It can build a relatinship f trust between patients and services, and can help t manage expectatins. In 2006, registratin with an NHS Dentist in Dumfries and Gallway std at 33% f the ppulatin, with a waiting list f ver 30,000. Cnsecutive Scttish Gvernments have implemented varius plicy initiatives t imprve access t NHS Dental Services. One methd f addressing the difficulties in access was t increase prvisin f Salaried General Dental Services in areas where access t Independent Cntractr General Dental Services was pr. NHS Dumfries and Gallway established 7 Salaried Dental Clinics thrughut the regin including: Dumfries Dental Centre, Lchmaben, Lchside, Castle Duglas, Newtn Stewart, Sanquhar and Stranraer. Withdrawal f prvisin f rutine General Dental Service by the Salaried Dental Service was undertaken in Castle Duglas in 2008 and in Stranraer in In April 2013, a new financial gvernance framewrk was intrduced fr Salaried General Dental Services. As part f this new financial framewrk an Annual Integrated Service and Financial Plan fr the Salaried Dental Service had t be submitted t the Scttish Gvernment befre they wuld agree the release f an earmarked financial allcatin directly t the Bard. In the guidance accmpanying the financial plan Scttish Gvernment advised that: Salaried GDS shuld nly be established in areas f unmet need r where there is difficulty in accessing GDS services. Equally, as access imprves in an area, bards shuld be actively managing a reductin in the size f the Salaried GDS wrkfrce. Since then a review f access t NHS dental services cncluded that access t NHS dental services had significantly imprved and that a number f independent dental cntractrs reprted that they had capacity t take n additinal patients. This led t the undertaking f a review f prvisin f rutine NHS general dental services by the Salaried Dental Service frm its existing clinics. Fllwing agreement f the NHS Bard this resulted in withdrawal f rutine NHS General Dental Services by the Salaried Dental Services at Dumfries Dental Centre (Specialist Dental Services and Training still remaining) and Lchmaben Dental Clinic. Plans are in place fr the withdrawal f dental services frm Newtn Stewart fr Spring The Bard attempted t prgress leasing arrangements f Sanquhar Dental Clinic and Lchside Clinic fr the cntinued prvisin f NHS Dental Services hwever, these arrangements were nt able t be prgressed. In Octber 2015 the NHS Bard agreed that the situatin with regard t Lchside shuld be further reviewed. Wh are we ging t invlve? The target audience are patients currently registered t receive NHS dental services frm the Lchside Dental clinic and thse individuals wh are resident in the Lchside and Lincluden area. We will need t take steps t ensure invlvement frm different sectrs f the cmmunity. The prcess shuld be inclusive s that participatin is pssible fr everyne, acrss the equality strands. Discussins with the clinic staff regarding the review are nging. Views f independent dental cntractrs will als be required. Benefits f invlving ur lcal cmmunities The invlvement f lcal peple ges sme way t ensure that lcal health needs are met.

18 Imprves lcal peples understanding f delivery f dental services Encurages cllabratin between grups that wuld nt traditinally wrk tgether in a planning prcess Gives insights int a cmmunity's needs and values that may nt therwise be btained. Peple may take mre wnership f their dental service and therefre utilise it and use it apprpriately. Pssible drawbacks The Bard may decide t prceed with recmmendatins that patients and/r the Cmmunity are nt happy with. A summary f patient and cmmunity feedback regarding the preferred ptin will be used t infrm the final equality and diversity impact assessment and a summary f the feedback will be included in the final Bard paper. This will hpefully prvide reassurance that the views f patients and cmmunity have been cnsidered. D we need any resurces? Sme resurces will be needed t carry ut the prpsal. These are: a) Staff time The Cnsultant Dental Public Health and Dental Services Manger will be respnsible fr devising the engagement prcess with cntributins frm the review wrking grup. Staff at the dental clinics will als need t cntribute sme time t help in the recruitment f vlunteers. b) Expenses - sme vlunteers and patients may need assistance with; travel r childcare csts. c) Refreshments will als be required d) Materials patient letters, psters, infrmatin leaflets and patient questinnaires. Hw are we ging t invlve peple? The fllwing invlvement is prpsed: Phase 1 - Engaging Patients and Lchside and Lincluden Cmmunity Phase 2 Optins Appraisal Phase 3 Infrming and Engaging f Preferred Optin Phase 4 Infrming f Bard s Decisin Phase 5 Reflecting and Learning These Phases are nw detailed belw. Phase 1 Engaging Patients and Lchside and Lincluden Cmmunity Expected Outcmes Patients will be aware f the review and able t prvide feedback n what matters t them regarding dental service prvisin. Members f the Lchside and Lincluden Cmmunity will be able t prvide feedback n their ral health needs and their experience f accessing dental services. Vlunteers fr the ptins appraisal prcess will be indentified. Infrmatin gained frm this phase, in cnjunctin with ther data surces will be used t infrm develpment f a shrt list f ptins fr future service delivery frm Lchside Clinic, which will then g thrugh an ptins appraisal prcess.

19 Phase 1 Aims T advise thse registered patients f Lchside clinic f the review and gain feedback n what matters t them in terms f dental services prvisin. T btain infrmatin n the reprted ral health needs and accessibility f dental services fr the Lchside and Lincluden cmmunity. Vlunteers fr the ptins appraisal will be recruited. Methd Letters will be sent t individual patients n the review and a questinnaire seeking feedback n what matters t them will be enclsed with the letter. Infrmatin n the review will be psted n the Health Bard s website The Participatry Appraisal netwrk will undertake wrk within the Lchside and Lincluden Cmmunity t gain feedback n ral health needs and accessibility f dental services. Infrmatin received will be used by the review grup t infrm a shrt list f ptins fr future service delivery. Respnsibility The Dental Services Manager will develp the patient letter, leaflet and questinnaire in cnjunctin with clleagues in patient experience and the Scttish Health Cuncil. The Dental Services Manger will be respnsible fr uplading relevant infrmatin n t the Health Bard website. The Dental Services Manager will be respnsible fr prviding a reprt n patient feedback. The Cnsultant in Dental Public Health will wrk with the Participatry Appraisal Netwrk t design the Lchside and Lincluden Cmmunity engagement. Clinic staff will help identify patients living in the Lchside and Lincluden Cmmunity wh may be willing t be invlved in the participatry appraisal. Cnsultant in Dental Public Health will be respnsible fr prducing Oral Health Needs Assessment Reprt f the Lchside and Lincluden Cmmunity. Cst Staff csts will be absrbed thrugh existing budgets Pster and leaflet csts will be absrbed thrugh existing budgets Timelines Feedback frm patients will be gathered between 6 th January 2016 t 10 th February 2016 Vlunteers fr the ptins appraisal will be identified by the 30 th f June 2016 The Participatry Appraisal will be undertaken between the 26 th f May and the 24 th f June with a reprt prvided by the 4 th f July Review grup meet n 14 th f July 2016 t cnsider patient feedback and Oral Health Needs Assessment t develp a shrt list f future service delivery ptins.

20 Phase 2 Optins Appraisal Expected Outcmes: Optins Appraisal will be cmpleted with patient and cmmunity representatin Preferred Optin will be identified Phase 2 Part 1 - Optins Appraisal Vlunteer Preparatin Aim Vlunteers will be apprpriately prepared fr participatin in the ptins appraisal prcess. Methd Vlunteers will be required t attend an initial briefing sessin prir t the ptins appraisal this will last 2 hurs. This will include the fllwing elements and will allw participants an pprtunity t ask further questins: Presentatin, including backgrund t review and prcess t date (including verview f hw the lng list was develped int a shrt list) Discussin f the backgrund infrmatin dcument t ensure participants can understand the dcuments prvided Outline f the ptins appraisal prcess and hw it will wrk A member f the Scttish Health Cuncil will attend the sessin t supprt participants. Respnsibility It will be the respnsibility f the Cnsultant Dental Public Health and Dental Service Manager t prvide the briefing sessin and prvide thse invlved with a backgrund infrmatin dcument cntaining relevant infrmatin and verview f the ptins appraisal prcess. Csts Staff time will be absrbed thrugh existing budgets Expenses fr participants will be meet thrugh Dental Services Budget Timeline It is hped that backgrund dcumentatin will be shared 1 week prir t the ptins appraisal. Pre ptins appraisal sessin will be undertaken the day prir t the ptins appraisal.

21 Phase 2 Part 2 Optins Appraisal Sessin Aim Vlunteers will participate in an ptins appraisal prcess Methd Phase 2 Expected Vlunteers Outcmes supprted by Scttish Health Cuncil will participate in the ptins appraisal. It is anticipated the T ptins acquire appraisal knwledge will n last the 5 hurs. needs An f the utline cmmunity f the ptins regarding appraisal the new prcess Health is Centre. detailed belw: T gain a cmmunity input int the develpment f the Centre. T Aims btain and a Objectives wider understanding f cmmunity health needs and pririties. T Overview achieve f an hw increased shrt list scial was capital develped / capacity building within the cmmunity. T Benefits give a sense and Risks f wnership f shrt listed f the ptins develpment by the lcal cmmunity. T Benefits give designers Criteria and planners ideas and suggestins that they have nt thught abut. Rank and Weighting Scring Prcess Cnsensus n the day Phase Next 2 Steps if apprpriate Invlving Peple in mve Respnsibility There are several methds that this culd be used and a cmbinatin f them shuld be cnsidered: It will be the respnsibility f the Cnsultant Dental Public Health and Dental Service Manager t develp Methd and 3: circulate the dcumentatin required fr the ptins appraisal It will Using be the lcal respnsibility grups: The f mve the Cnsultant may affect sme in Dental lcal cmmunity Public Health grups t secure and it may a facilitatr be pssible fr t the sessin apprach them t ask if their clients/members wuld be willing t take part in a fcus grup r survey. It will Often be the respnsibility grups will run f these the themselves. Dental Services Manager t prvide a nte taker fr the sessin Methd 4: Csts Invlving partner rganisatins:. i.e. Health and Scial Care These grups may want t lk at invlving their clients/members in any cnsideratins. Methds and appraches wuld need t be Staff explred time will t be establish absrbed the mst thrugh apprpriate existing way budgets f invlving. Expenses fr participants will be meet thrugh Dental Services Budget Timeline The aim is t cmplete the qualitative aspects f the ptins appraisal n the day via undertaking cnsensus scring. The financial appraisals will be undertaken fllwing the utcme f the appraisal.

22 Phase 3 Infrming and Engaging f Preferred Optin Expected utcmes Patients will be infrmed f the preferred ptin fllwing ptins appraisal Patients will understand what the results f any prpsed change wuld mean fr them Patients will be able t prvide their feedback n the preferred ptin fr the Lchside clinic Feedback will be given t the Lchside and Lincluden Cmmunity n the findings f the Oral Health Needs Assessment and als f the preferred ptin fr the Lchside Clinic Peple in the Lchside and Lincluden Cmmunity will be able t prvide their feedback n the preferred ptin fr the Lchside Clinic Feedback frm patients and the Lchside and Lincluden Cmmunity will help infrm the final recmmendatins and the decisin making prcess Patients will understand when and where a decisin will be made Independent Dental Cntractrs will be infrmed f the preferred ptin Phase 3 Infrming and Engaging f Preferred Optin Aim Patients are aware f the recmmendatin made fr their clinic and are knwledgeable abut what this might mean fr them and are able t prvide their feedback n this. The Lchside and Lincluden Cmmunity will be are aware f the recmmendatins frm the needs assessment and have been able t prvide their feedback. Independent Dental Cntractrs will be infrmed f the preferred ptin Methd This can be achieved thrugh: Letters will be sent t ptins appraisal participants utlining the results and preferred ptin and the next steps. Prductin f a patient feedback sheet utlining what this wuld mean fr patients and where they can get further infrmatin will be available at the clinic and the Health Bard Website. Individual patients will be lettered n the preferred ptin, given a patient infrmatin leaflet and prvided with a feedback frm. A briefing paper will be prepared fr lcal cuncillrs and MSPs representing Nrth West Dumfries. The preferred ptin fr the clinic will be displayed at the clinic and n the Bard Website. Links t the Bard website will be psted n the Bard facebk page and twitter accunt A summary f the high level needs assessment results and preferred ptin will be made available at cmmunity sites invlved in the participatry appraisal with infrmatin available n hw t prvide feedback n this Cmments received frm patients and the Lchside and Lincluden Cmmunity will be summarised and used t infrm the final equality and diversity impact assessment and a summary f cmments will be included in the final Bard paper. A summary dcument f the respnses will be upladed t the Bard website and will be available n request. A paper n the preferred ptin will be presented t the Dental Advisry Cmmittee Feedback n the preferred ptin will be sught frm independent dental cntractrs Respnsibility It will be the respnsibility f the Dental Services Manager t prvide letters/psters/inf leaflets/patient feedback sheets fr the patients / clinic, these will be develped in partnership with the Scttish Health Cuncil and Cmmunicatins Team. It will be the respnsibility f the Dental Services Manager t uplad these dcuments n the Bard website. It will be the respnsibility f the Cnsultant in Dental Public Health t send a letter t the Optins Appraisal participants t advise f the results f the preferred ptins. It will be the respnsibility f the Cnsultant in Dental Public Health/Dental Service Manager t prduce the feedback summary in regard t the preferred ptin in cllabratin with the Scttish Health Cuncil It will be the respnsibility f the Dental Services manager t uplad the patient feedback cmments nt the Health Bard website. Csts Staff csts will be absrbed thrugh existing budgets Pster and leaflet csts will be absrbed thrugh existing budgets Timeline Infrming f patients and public will take place nce this has been signed ff by the Integrated Jint Bard and Clinic Staff have been advised f the preferred ptin